April 29 Newsletter

 

 

 

 

April 29, 2026

 

HCAM Awards of Excellence: Nominate Someone Today!

Nominations for scholarships and Awards of Excellence to honor individuals, teams and residents in Michigan’s skilled nursing and assisted living sectors are open until May 15. It takes time to gather all the needed information and materials, so you may want to start the process today. Get all the details on the award categories and link to each award’s nomination form.

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It’s Not Too Late to Attend the U.P. Conference

We’re hosting a top-notch event in Marquette with timely, relevant sessions for skilled nursing facilities and assisted living communities, as well as helpful and fun networking opportunities. Register now to join your colleagues on May 4-5, 2026.

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Call for Nominations for National Champion of Quality Award

The nomination period for the American Health Care Association Mary K. Ousley Champion of Quality award is now open. We encourage members to participate and help recognize outstanding national contributions to quality improvement.

Key Details:

  • Nomination Period: Now through May 29, 2026.
  • Submission Process: Nominations must be submitted through Award Force. Create an account to get started and then complete the nomination questions.
  • Types of Nominations: Both peer nominations and self-nominations are welcome.
  • Nomination Requirements: Nominees must have significantly advanced quality care on a national level in nursing facilities, assisted living or post-acute care.
  • Questions? Email ACHA’s Holly Norelli.
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CMS Updates Guidance for Vaccine Coding on SNF Claims

The Centers for Medicare and Medicaid Services (CMS) provided updated guidance for institutional providers for coding claims for vaccine administration when the vaccination is the only service billed on the claim. The updated vaccine codes are effective for dates of service (visits/encounters) starting April 13, 2026. See the instruction to your Medicare Administrative Contractor (PDF).  Additional vaccine billing guidance can be found at the AHCA/NCAL #GetVaccinated resources page.

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CMS Posts Updated SNF Consolidated Billing HCPCS Code Tables

The Centers for Medicare and Medicaid Services (CMS) published a quarterly update to the SNF consolidated billing Healthcare Common Procedure Coding System (HCPCS) code tables for 2026. These updates are effective July 1, 2026.  

HCPCS codes are ordinarily billed under Medicare Part B payment policies; however, due to SNF consolidated billing provisions, the codes on these tables represent services that cannot be billed by any provider other than a SNF during a beneficiary’s SNF stay. Additionally, during Part A covered stay, many of these services are bundled into the Part A SNF prospective payment system per-diem rate and cannot be unbundled and billed to Part B. These tables also list HCPCS codes that meet a limited number of statutory exclusions from the SNF Consolidated billing policy and can be billed separately under Part B. A general explanation of the major categories of services excluded from SNF CB can be found here. A listing of all HCPCS coded added or deleted beginning July 1 are listed here​.

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Medicare Advantage Improvement Act of 2026 Introduced

The U.S. House of Representatives introduced the Medicare Advantage Improvement Act (MAIA) of 2026 (H.R. 8375), a bipartisan bill that addresses critical issues within Medicare Advantage (MA). The bill focuses on issues such as prior authorizations, prompt pay, payment clawbacks and transparency. This is a step towards ensuring the MA program delivers on its promise to provide seniors access to timely, medically necessary care.   

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Deadline: HCP Influenza Reporting (SNF)

The deadline for nursing facilities to report health care personnel (HCP) influenza vaccination coverage in the Centers for Disease Control and Prevention’s National Health Safety Network (NHSN) is May 18. CMS requires this reporting for SNF Quality Reporting Program (QRP). 

The reporting period for the 2025-2026 influenza season is from October 1, 2025, through March 31, 2026. Facilities are only required to submit one report that covers the entire reporting period by May 18, 2026.

Failure to report complete data in NHSN by 11:59pm on May 18 will result in a 2% reduction in a nursing facility’s annual Medicare reimbursement rates. 

Tips for Reporting the Annual Influenza HCP Vaccination Data:

  • Facilities are strongly advised not to wait until the deadline to report. If your facility has not yet submitted its data, it is advised to submit now.
    • Data is submitted via the Healthcare Personnel Influenza Vaccination Summary Form, NOT the Seasonal Survey on Influenza Vaccination Programs for Healthcare Personnel (the latter is optional).
  • Confirm data entry after submission:
    • Print the data entry screen (or take a screenshot).
    • Run the CMS Report Line Listing – HCP Flu Vaccination Data for CMS SNF PPS in the NHSN application.
    • Training materials are available on the NHSN website.
  • If your facility is having difficulty accessing the NHSN Healthcare Personnel Safety (HPS) Component to submit this data, email [email protected] with “HCP Flu Summary” in the subject line and specify that you are a LTC facility.

SNF QRP requirement questions? Email [email protected].

AHCA resources to assist with NHSN reporting:

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Updated FAQs for SNF Data Validation Process (SNF)

The Centers for Medicare & Medicaid Services (CMS) recently updated its Data Validation Process Frequently Asked Questions document with several revisions: 

  • CMS added several new FAQs addressing how facilities should designate Points of Contact (POCs) for the validation process.  
  • CMS clarified the SNF Validation Process data submission deadline:  
    • Facilities must submit all requested medical records within 45 days of the initial selection notification. Records are due by 11:59 PM on the 45th day. If the 45th day falls on a weekend or federal holiday, facilities must submit records by 11:59 PM on the next business day.  
  • CMS added a new FAQ explaining when facilities will receive their summary reports (audit results). CMS makes summary reports available in iQIES within three months after the medical record submission deadline.  

CMS notifies selected facilities through their MDS 3.0 Provider Preview Reports in iQIES throughout the year. Facilities should check their iQIES folders at least twice per week to ensure a timely response if selected.

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PBJ Submission Deadline is May 15 (SNF)

Providers must submit their Payroll Based Journal (PBJ) data for Quarter 2 (January 1 – March 31, 2026) by May 15, 2026. As providers prepare submission, please remember: 

  • All PBJ XML files must be submitted using Version 4.10.0. Providers should confirm that their internal systems and any contracted vendors have fully transitioned to Version 4.10.0 before submitting Q2 data.  
  • Any XML file submitted using a prior version will be rejected. 

What’s changing in version 4.10.0: 

  • Users will no longer be able to submit more than 22.5 hours per employee ID per day across all job titles. 
  • If your facility uses linked employee IDs, continue to ensure that the total hours for one system ID (representing one person) do not exceed 22.5 hours. 
  • Users will no longer receive a warning for hire or termination dates for 2026 and beyond. 

At minimum, providers should: 

  • Verify all reported hours, including Medical Director hours.  
  • Review PBJ validation reports for errors or warnings.  
  • Confirm that no files were rejected during submission.  
  • Ensure the correct reporting quarter was selected . 
  • Validate employee IDs and job codes for accuracy.  
  • Review the Final File Validation Report.
  • Review All PBJ CASPER Reports.

CMS resources for PBJ support: 

All files must be submitted by May 15, 2026, at 11:59 pm EST.

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CDC Webinar: NHSN RVP Module Updates (SNF)

The Center for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) Long Term Care Team and Prevention & Therapeutics Unit will hold a training webinar on the Respiratory Pathogens and Vaccination (RVP) Module at 1 pm EST on April 30, 2026. 

The webinar will review the following topics:  

  • Optional Reporting of Therapeutic Medications – Facilities can now use the RPV Module to optionally report therapeutic medications given to residents diagnosed with COVID-19, influenza, or respiratory syncytial virus (RSV).  
  • Updates to the Person-Level Vaccination Form for Residents – The form now auto-calculates a resident’s vaccination status for COVID-19, influenza and RSV.  
  • Up-to-Date Definition for COVID-19 Vaccines for Quarter 1 and 2 of 2026 (12/29/25 – 6/28/26) – There is no change to the Up-to-Date definition for COVID-19 vaccines for Quarter 1 and 2 of 2026. 

Pre-registration is required to attend the webinars. In addition, you submit questions to the NHSN Help Desk via NHSN-ServiceNow using the subject line “LTCF RPV Webinar.” If you are unable to access ServiceNow, please submit a question to the Help Desk via email with the same subject line.

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New CMS Training: Re-Specification of Falls with Major Injury QM (SNF)

​​​The Centers for Medicare & Medicaid Services (CMS) posted a web-based training that provides the latest information about the future re-specification of the Falls with Major Injury (FMI) Quality Measure (QM) for nursing facilities and other post-acute care settings. The training provides an overview of the legacy and respecified FMI Measure, discusses how the changes to the measure include both assessment and claims/encounter data in the respecified measure specifications. It also reviews key changes in the Minimum Date Set data collection guidance related to falls and injuries. CMS has not posted a time frame for transition to the respecified measure at this time. 

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It’s Not Too Late to Attend the U.P. Conference

We’re hosting a top-notch event in Marquette with timely, relevant sessions for assisted living communities as well as helpful and fun networking opportunities. Specific assisted living topics include:

  • AFC/HFA Updates
  • Tips for Maximizing First Impressions
  • 5 Marketing Must Haves for Senior Living 
  • How Defensible is Your Assisted Living Community 
  • Promote with Purpose: Preparing First-Time Leaders for Success in Senior Living
  • QAPI for Assisted Living

Additional session topics include:

  • Opening Keynote: Crisis Leadership & Administrator/Executive Director Burnout
  • Employment Law Update
  • Implicit Bias – How it Impacts our Work

Register now to join the HCAM team along with your long-term and post-acute care colleagues in Marquette on May 4-5, 2026

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Apply Now for HCAM Assisted Living Scholarship and Other AL Awards

The nominating period is open until May 15 for HCAM’s Assisted Living Scholarship as well as the association’s long-term care awards of excellence for assisted living teams, individuals and residents. HCAM’s Assisted Living Scholarship can help employees meet education expenses and advance the long-term care profession. Scholarship applicants must be employed for at least one year by an HCAM assisted living community member in good standing and be enrolled in an education program related to long-term care at an accredited college or university. This can include, but is not limited to, life enrichment, direct care, administration, sales, cooking, maintenance, med tech, occupational therapy and other related fields. HCAM will award up to two $2,500 scholarships. Get the details here. 

HCAM also offers awards for assisted living settings in three categories (1) Team of Excellence, (2) Gerry Baker Hero of Health Care and (3) Resident of the Year. Find out more here. 

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Long-Term Care Data Cooperative for Assisted Living

Data is the foundation of quality improvement in assisted living. The Long-Term Care (LTC) Data Cooperative, supported by the National Institute on Aging, enables assisted living providers to transform electronic health record data into actionable insights that drive better outcomes, strengthen operations, and support informed decision-making. More than 1,000 providers are already participating and benefiting from these insights. These providers are now receiving reports on key measures such as vaccinations, medications, lab orders, and hospitalizations. Join the LTC Data Cooperative to access these insights and help shape the future of assisted living! To begin enrollment please fill out this form. Questions? Email [email protected].

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